Provider Demographics
NPI:1407805740
Name:VALLEY PRIMARY EYE CARE PC
Entity Type:Organization
Organization Name:VALLEY PRIMARY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARAKAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-264-4664
Mailing Address - Street 1:1088 HOWERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CATASAUQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18032-1615
Mailing Address - Country:US
Mailing Address - Phone:610-264-4664
Mailing Address - Fax:610-264-5202
Practice Address - Street 1:1088 HOWERTOWN RD
Practice Address - Street 2:
Practice Address - City:CATASAUQUA
Practice Address - State:PA
Practice Address - Zip Code:18032-1615
Practice Address - Country:US
Practice Address - Phone:610-264-4664
Practice Address - Fax:610-264-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3544742OtherAETNA USHC
PA3000218OtherKHPC
PAVA16118991OtherHIGHMARK BS
PAO2498300OtherBLUE CROSS
PAO2498300OtherBLUE CROSS
PA3000218OtherKHPC
PA5143710001Medicare NSC